Enteric Leaks from Simultaneous Pancreas Kidney Transplantation at a Single Centre: Risk Factors and Management Over a 20-Year Period

Background: Simultaneous pancreas-kidney transplantation (SPK) remains the gold standard treatment for patients with type I diabetes mellitus and end-stage renal failure. Enteric drainage is utilised to handle exocrine secretions from the graft, with enteric leaks being the most challenging of complications. There remains a lack of published research regarding risk factors for enteric leaks. Methods: As such we undertook a retrospective cohort study of SPK transplants performed at Westmead Hospital over twenty years (between 1998-2017, n=425) to identify the occurrence of enteric leaks as well as donor, recipient and transplantation procedure risk factors. Descriptive statistics were generated using SPSS version 22.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). The student’s t-test and/or Mann-Whitney U test was used to detect significance. All tests were two tailed and any statistically significant difference was considered at the P <0.05 level. Results: Of the 425 patients, 16 (3.5%) experienced an enteric leak. Of these, 12 (80%) had significant vascular disease, defined as coronary artery disease, cerebrovascular disease, retinopathy, peripheral neuropathy or peripheral vascular disease requiring surgical intervention. The risk of an enteric leak increased in recipients with significant vascular disease. Conclusion: The rates at Westmead Hospital were lower than those published in the literature. We demonstrated that the presence of significant vascular disease predisposed recipients to enteric leak. These findings highlight the importance of careful donor and recipient selection to optimise patient outcomes.